Provider Demographics
NPI:1174333223
Name:HIEBERT, RUSTIN GAILE (DPT)
Entity type:Individual
Prefix:
First Name:RUSTIN
Middle Name:GAILE
Last Name:HIEBERT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6032 ALHAMBRA DR
Mailing Address - Street 2:
Mailing Address - City:FAIRWAY
Mailing Address - State:KS
Mailing Address - Zip Code:66205-3159
Mailing Address - Country:US
Mailing Address - Phone:913-484-0741
Mailing Address - Fax:
Practice Address - Street 1:11340 NALL AVE STE 200B
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-2485
Practice Address - Country:US
Practice Address - Phone:913-354-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-062402251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic